Topical Hyaluronic Acid Adjunctive Effects on Healing After Free Gingival Grafting in Smokers and Non-Smokers

Free gingival graft (FGG) surgery leaves an open wound at the palatal donor site, which heals by secondary intention and can cause patient discomfort. Various adjunctive materials, such as stents, collagen sponges, platelet-rich fibrin, and hyaluronic acid (HA), have been explored to improve healing. HA is a naturally occurring glycosaminoglycan with hydrating, anti-inflammatory, and pro-regenerative properties that support fibroblast and keratinocyte activity and promote angiogenesis. These qualities make HA a promising adjunct for enhancing wound healing in periodontal surgery. However, few studies have assessed its clinical impact on palatal donor site healing after FGG, and in existing studies HA was applied only once by the operator rather than used consistently by patients. This study evaluates daily, patient-applied HA gel to address this gap and compare outcomes in smokers and non-smokers.